Extended thromboprophylaxis for medically ill patients with cancer: A systemic review and meta-analysis

Abstract

Hospitalized medically ill patients with cancer are at increased risk of both venous thromboembolism and bleeding. The safety and efficacy of extended thromboprophylaxis in patients with cancer are unclear.Weconducted a systematic review and meta-analysis of the literature using ofMEDLINE, EMBASE, and the Cochrane CENTRAL databases to identify cancer subgroups enrolled in randomized controlled trials evaluating extended thromboprophylaxis following hospitalization. The primary outcomes were symptomatic and incidental venous thromboembolic events and hemorrhage (major hemorrhage and clinically relevant nonmajor bleeding). Four randomized controlled trials reported the outcomes of extended thromboprophylaxis in 3655medically ill patients with active or history of cancer. The rates of venous thromboembolic events were similar between the extended-duration and standardduration groups (odds ratio [OR], 0.85; 95% confidence interval [CI], 0.61-1.18; I2=0%). However, major and clinically relevant nonmajor bleeding occurred significantly more frequently in the extended-duration thromboprophylaxis group (OR, 2.10; 95% CI, 1.33-3.35; I2 = 8%). Extended thromboprophylaxis in hospitalized medically ill patientswith cancerwas not associatedwith a reduced rate of venous thromboembolic events but was associated with increased risk of hemorrhage.